EL-14-1950Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-219178 Permit Number: EL -9-14-1950
Scheduled Inspection Date: December 04, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: HURLEY, JAMES Work Classification: Generator
Job Address: 685 GRAND CONCOURSE
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: HENRY AND CO
ounaing veparLment %,omments
INSTALL 20 KW GENERATOR, ATS AND PRE CAST PAD. Infractio
INSPECTOR COMMENTS
Phone Number
Parcel Number
False
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
1132060172180
Phone: (954)527-1597
December 03, 2014 For Inspections please call: (305)762-4949 Page 9 of 46
N
i f
Miami Shores Village CE1V '
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138"} SE(r4
Zo��
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 uQ)
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑ BUILDING 0 ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [:]RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB A�S: GRAND CONCOURSE
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:1132060172180 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): JAMES HURLEY Phone#:
Address: GRAND CONCOURSE
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: HENRY AND CO
Address: 757 SE 17 ST 176
City. FT LAUDERDALE State: FL
Qualifier Name: HENRY KARP
one#: 954-527-1597
Zip: 33318
hone#: 954-527-1957
State Certification or Registration #: EC0001322 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City:
Value of Work for this Permit: $ r �.� L� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration Z9.New ❑ Repair/Replace
Description of Work: INSTALL 20 KW GENERATOR, ATS AND PRE CAST PAD
Specify color of color thru the:
Submittal Fee $ Permit Fee $ CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
(Revised02/24/2014)
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company'S Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature ,–:yt Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
4 day of (.0 20 by 'r day of Q 20 by
(�(�p6; who is ersonally known to who is a sm
onally own to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign:!�-M R0 c ��T.C�"`� Sign: i -4c� -4 Q�� —
Print: VAA2� an P LL. (.t�Cx-� s� Print:��---
Seal• 1VOTARYPL78LIC-STATE OFFLO-,-A. Seal: NOTARYPLBLIC-STA
Melanie Watson """' b�elanie Watson
... OComrllission # EE058519 COM=ssiOn # EE058519
w-- Expires: FEB, 1 , 2015°° Ex ices:
�x�*�+�*�**�*+►*�*�a**x�***x*�*x*�®,%,�
cco, • �
cb /
APPROVED BY P laps Examiner �® t� Zoning
s _
Structural Review Clerk
(Rev1sed02/24/2014)
KARP, HENRY
HENRY KARP, INC. DBA HENRY AND CO.
400 SOUTHWEST 16TH STREET
FT LAUDERDALE FL 33315
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque restaurants
and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to
serve you better. For information about our services, please log onto
www.myfloridalleense.com. There you can find more information
about our divisions and the regulations that impact you, subscribe
to department newsletters and team more about the Department's
initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers, Thank you for doing business in Florida,
and congratulations on your new license!
DETACH HERE
`HENRY
JS CERTIFIED under the pf
AUG 31,2016
IM•
M
aions of Ch.489-FS,
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 3o, 2015
DBA: HENRY AND CO
Business Name: HENRY KARP INC
Owner Name: HENRY KARP
Business Location: 757 SE 17 ST 176
FT LAUDERDALE
Business Phone: 954-527-1597
Receipt#:181-2832
LECTRICAL/ALARMS/CONTE
Business Type: (ELECTRICAL CONTRACTOR)
Business Opened:09/03/1980
State/County/CertfReg:80-CME 686X
Exemption Code:
Rooms Seats Employees Machines Professionals
1
For Vending Business Only
Number of Machines: Vending Tvg)e:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
1
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
HENRY KARP INC
757 SE 17 ST #176
FT LAUDERDALE, FL
33316
2014 -2015
Receipt #01A-13-00005711
Paid 08/05/2014 27.00
CERTIFICATE OF
LIABILITY
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE% THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. OF DOES NOTs sAUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: the ceftificAte, holderan ADDITIONAL M e. poitc-Ales) must be endomed. If SUBROGATION IS WAIVED. suNm to
Ow terms and condillom of the PolICY, certain Polivies may require an andomemern. A sMement on this "Itificaftl does not confer r4ft to the
cartiftaln
C+ s a
r.. , COVERAGE
INSURER A: SCOTTSDALE INSURANCE
MIT ti s V
€ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L
PQ F
TYPE OF INSURANCE POLICY NUMBER O w
Department
LIMITS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
GENERAL. LIABILITY
EACH OCCUF%RENCE $ 114001000
THE EXPIRATION (SATE THEREOF. NOTICE WILL
X COMMERCIAL GENERAL LIABILITY i � �
10050
E �r I $ 100,000 i
RS D EXIT (Arty one pc4mi) 13 5,000
{j
CLA1 LADE CBC i UR i i
_� _KZ T -N
I
03/08/25
PERSONAL & Auvl sRv 13 1,000,000
GENERAL AGGREGATE i$ 2,000,000
PRODUCTS - CtMPIOPAGG 1 S 1,000,000
OENL AOGRECaATE Li4AiT APPLIES PER -
C
POLICY [7 PRO' LOC
•
(
A EI REPRESCUTATi' E
`
$
I
(
AUTOMOBILE
LIABILFTY
. _..
__.....
Ea ai nl
BODILY IMURY (Per person) $
j
r
ANYAUTO
({
I
r erved,
ALL OWNED j SCHEDULED
AUTOS AUTOS
�� WNEOPROPERTY
MIRED AUTO$ (AUTO$ercraci3»I
I
and logo are registered marks of ACORD
BODILY INJURY (F d6rd) $
OAMAGff---
i$
UMBRELLA LLAB OCCUR
EA t OCC11RRENCE i $
M'
EXCESS il." 4 I AIMS MADE -
€ AGGREGATE is
$
i
DED RETENT' N $
WORKERS C.Qt4PEId$09XS}Pd
AND EMPLOYERS, LIABILITY IN
Yt^'�'�sA
f
€ T C STA'LI O '•
E.L, EACH ACCIDENT $
ANY PROP'Ria»'sOKPARTMEPeMCI TNT k i
j dSFr"i YaEAaH St C1 V=
tY to k
d
U eeCrils+andar
E.L. DISEASE • EA EMPLOYEE$
E.L. DISEASE • POLICY LIMIT $
IPTIDN OF OPERATIONS w1ow i
a
I
I
i
i
DESCRIPTEON OF OPERATIONS i LOCATIONS r VEHICLES ',ALL o. ACC9RD 361, AddVanal Remarks Schedule: ri inose waw is regu)red}
;Electrical Contractor Lic. Number SCO001322
i
I
1
a
Miami
Shores Village
Building
Department
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
CANCELLED BEFORE
THE EXPIRATION (SATE THEREOF. NOTICE WILL
BE DELIVERED IN
10050
NE 2 Av
ACCORDANCE WITH THE POLICY PROVISIONS,
Miami
Shores FL 33138
A EI REPRESCUTATi' E
`
S s
f
�
r
19$ 2011°5 ACORD CORPORATION,
r erved,
ACiaRQ25(2Ci1 t05)
The A ORD name
and logo are registered marks of ACORD
§Roi- a
• ye H
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 3/16/2014 EXPIRATION DATE: 3/15/2016
PERSON: KARP HENRY
FEIN: 592307048
BUSINESS NAME AND ADDRESS:
HENRY KARP INC
HENRY AND CO
400 SW 16 ST
FT LAUDERDALE FL 33315
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of eiection urcer section may not recover
benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S.. Certificates of election to be exempt. apply only witrir :re sc--ce of the business or trade
listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F S.. Notices of election to be exempt and certificates of elecrcn to ce exemot shall be subject to
revocation if, at any time after the filing of the notice or the issuance of the certificate. the person named on the notice or certificate nc lon=er -ee:s :^e regjirements of this
section for issuance of a certificate. The department shall revoke a certificate at a^y !Ime for failure of the oerso^ ^a—ec cr .,ie cerci ca:e :: —e. ^e rea.: emen!s of this
section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REviSED C7-:2 =="'CC'S' '850)413-1609
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers jn the construction industry to exempt themselves from this requirement for any construction project
prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate
officers or members of a limited liability company (LLC) in the construction industry may
elect to be exempt if -
The officer owns at least 10 percent of the stock of the corporation, or in the case
of an LLC, a statement attesting to the minimum 10 percent ownership;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members
are allowed to be exempt. Construction exemptions are valid for a period of two years or until .
a voluhtary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be
personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Print Name:
Owner
State of Florida )
County of Miami -Dade )
Sworn to and subscribed before me s
day of , 20
B
NOTARY PUBLIC -STATE OF FLORIDA
(SEAL)4 ...... !,?0-4inip Watson
Tvpe of Identificatidii mission ,� PFn.SRSi 9
THRU ATLAN71C BO\ -DD iG CO., INC.
Contractor
Print Name:
Signature:
State of Florida )
County of Miami -Dade)
Sworn to and subscribed before , tl�s
day of �— , 29 Lf
1v TARYPUBLIC-STA`MOFFLO1_MA
(SEAL) °h -Melanie Watsnn
Type of Identific .fission # Hposto
bnp�'LAJJII tv: M. 11, LN 1
'tM&D TMU ATLANTIC B0XD30 go,, j�4,
Proposal
Henry And Co
State Licensed Generator and Electrical Contractor
FL State Lic. EC0001322 757 S.E 17ST #176 FT LAUD. FL 33318 EST 1979
John Cramer
CELL 954 605 6981
OFF 954 630 3880 FAX 954 561 2444
To Jim Hurley 7/21/2014
685 Grand Concourse Miami Shores Florida
305 789 9200 OFF 305 582 9845 Cell
JHurley@fowler-white.com jnh@fowler-white.com
Scope of Work: Turnkey installation of Generator
Provide and install new Generac 20 KW 6244 generator with Aluminum enclosure
Automatic transfer switches RTSY200A3
Concrete pad
500 gallon underground propane tank fill opacity 400 gallons
All necessary electrical work
All necessary gas work to connect generator to propane tank
All necessary tunneling / patching / concrete / cement / sod
Removal of all debris
Engineer's Drawings
Installations according to NEC 702 / Engineer's Drawings / Existing building Codes
All negotiations with Building & Fire Dept to secure all necessary permits
All necessary Insurance
All Miscellaneous parts / labor to install the above
Break in service, orientation & start up included
Not Included:
survey / fuel / permit costs / bushes to obscure review
Warranties:
Five year factory warranty
One year on all electrical installation
State / County / City inspectors having authority may request additional work and or
repairs not pertaining to generator installation that are not outlined in this proposal and
will be negotiated separately.
Attorney Fees: The prevailing party is entitled to recover anorneys's fees and costs in an
action to enforce this agreement.Deposit is nonrefundable.
Total
Deposit $6,500.00
Due on delivery of generator $6,500.00
Due on fi I electrical it
$15,000.00
gL
'15 '